Project 2- Abstract The incidence of oral cancer in minorities residing in Washington, D.C. are the highest in the country, (CDC, June 2012); While intra-oral exams may detect precancerous lesions with visual examination, HPV-associated oral cancer is found predominantly in the pharynx, a location not easily accessible during intra-oral exam. Furthermore, a high proportion of individuals in the community are not currently under routine medical or dental care. Therefore, we aim to establish a pilot community cohort to study association between oral health status, factors influencing barriers to oral care and oral pre- cancerous conditions and oral cancerous lesions. Our hypothesis is that the minority population in the Washington DC displays a higher prevalence of precancerous oral lesions and HPV-positivity than the general US population, and possesses barriers to receiving routine oral health care and oral cancer screenings. Our Specific Aims are: 1) To conduct a qualitative study engaging stakeholders and a focus group to identify barriers and needs of oral health care and oral cancer prevention in the DC minority community. 2) To establish a pilot cohort of patients in the local Washington DC minority community to determine the prevalence of pre-cancerous oral lesions and prevalence of HPV sub-types using brush biopsy and oral rinse techniques of cell collection, respectively, 3) To determine the association of periodontal inflammation with oral precancerous lesions, oral cancer, HPV positivity, and HPV-associated oral cancer in the US population by analyzing the NHANES data. If our program is successful, this project will serve as a model for a larger screening and clinical research program in the future and lead to additional grants. In the long-term, our study has at least 3 implications: 1) it will underscore the importance of oral cancer screening by dental providers in the Washington D.C. population; 2) it will increase the awareness of the importance of referrals to dentists for oral cancer screenings, and ultimately, 3) it will improve survival rates for those with oral cancer by early detection and routine oral cancer screening and improved oral health education and treatment.